Magnetic resonance imaging of miliary tuberculosis of the central nervous system in children with tuberculous meningitis.
BACKGROUND
Tuberculous meningitis (TBM) is closely associated with miliary tuberculosis and a pathogenetic relationship is suspected, although it has been proposed that the two processes are unrelated.


OBJECTIVE
To describe miliary tuberculosis of the central nervous system (CNS) on MRI in children with TBM.


METHODS
A retrospective descriptive study of 32 paediatric TBM patients referred for MRI. The presence of miliary nodules in the CNS was recorded. Lesions were categorized according to their distribution, enhancement pattern, size and signal characteristics.


RESULTS
A miliary distribution of nodules was present in 88% of patients. All patients with a miliary distribution had leptomeningeal nodules and 18% of these patients had deep parenchymal nodules in addition. At least one tuberculoma with central T2 hypointensity was identified in 39% of patients.


CONCLUSIONS
The high prevalence of miliary leptomeningeal nodules in the CNS of children with TBM is significant because it points to a pathogenetic relationship that has long been suspected on epidemiological grounds. Our findings challenge the concept that miliary tuberculosis is only an incidental finding in TBM patients and suggest that it plays an integral part in the pathogenesis.
Janse van Rensburg
Pieter
P
Department of Radiology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa. topieter@yahoo.com
Andronikou
Savvas
S
van Toorn
Ronald
R
Pienaar
Manana
M
D000293:Adolescent; D001921:Brain / Q000473:pathology; D002490:Central Nervous System / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015995:Prevalence; D012189:Retrospective Studies; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000453:epidemiology*; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*
D003287:Contrast Media; D019786:Gadolinium DTPA